Education  |   July 2018
Anomalous Drainage of Inferior Vena Cava into the Left Atrium
Author Notes
  • From the Departments of Pediatric Anesthesiology (S.C.) and General Anesthesiology (S.K.), Anesthesiology Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Address correspondence to Dr. Chhabada: chhabas@ccf.org
Article Information
Education / Images in Anesthesiology / Cardiovascular Anesthesia
Education   |   July 2018
Anomalous Drainage of Inferior Vena Cava into the Left Atrium
Anesthesiology 7 2018, Vol.129, 191. doi:10.1097/ALN.0000000000002169
Anesthesiology 7 2018, Vol.129, 191. doi:10.1097/ALN.0000000000002169
ANOMALOUS drainage of the inferior vena cava into the left atrium is a rare cause of cyanosis in adults.1  The accompanying images exhibit this condition. Magnetic resonance imaging portrays the inferior vena cava entering the left atrium (top image). An ostium secundum atrial septal defect and a prominent left atrial eustachian valve are present (bottom image). Contrast injection into the inferior vena cava confirms anomalous drainage into the left atrium (video, Supplemental Digital Content, http://links.lww.com/ALN/B670, exhibits left atrial drainage of inferior vena cava).
Deoxygenated blood from the inferior vena cava empties into left atrium, resulting in venous admixture. The left ventricle ejects this admixed blood into the systemic circulation. The ensuing cyanosis and persistent hypoxemia lead to erythrocytosis and hyperviscosity.